Nursing Home Administrator Exam

The finance exam

The National Association of Long Term Care Administrator Boards (NAB) is composed of state boards or agencies responsible for licensing long-term care administrators. One of NAB's functions is the development of the national nursing home administrator exam. Here's a look at finance.

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  • develop annual operating and capital budgets to effectively forecast fiscal requirements
  • manage annual operating and capital budgets to effectively use fiscal resources
  • generate and collect revenue to ensure financial viability of the facility
  • negotiate, interpret, and implement contractual agreements (e.g., organized labor, managed care, vendors, consultative services)
  • ensure the integrity of financial audit programs and reporting systems
  • ensure protection of the facility’s financial assets (e.g., insurance coverage, risk management)
  • ensure that financial practices are planned, implemented, and audited to comply with federal and state standards and regulations.

To do this, you should have knowledge of:

  • federal and state regulations affecting nursing home reimbursement
  • budgeting methods and financial planning
  • accounting methods
  • financial statements
  • reimbursement sources and methods
  • additional revenue sources
  • internal controls
  • payroll procedures and documentation
  • billing, accounts receivable, and collections management
  • accounts payable procedures
  • eligibility and coverage requirements from third-party payers
  • resident trust fund
  • importance of integration of clinical and financial systems
  • contracts
  • general and professional liability insurance

You should possess skills in:

  • analyzing and interpreting budgets and financial statements
  • interpreting financial regulations as they apply to reimbursement
  • managing cash flow
  • analyzing and identifying trends in the financial performance of the facility

There are a total of 150 questions on the examination, which are broken down as follows:

  1. Resident Centered Care and Quality of Life (57 questions)
  2. Human Resources (20 questions)
  3. Finance (19 questions)
  4. Environment (22 questions)
  5. Leadership & Management (32 questions)

In addition, there are 15 sample questions that will not affect a candidate's score. These sample questions are randomly distributed throughout the exam.

Measure of Real Success

An exam will give people the baseline for entering the profession. The real keys to success go beyond that. Consider:

  • Your number one priority should be the care of your residents. 
  • The successful administrator makes time to make rounds.
  • The successful administrator builds a cohesive team.
  • The successful administrator has empathy.
  • The successful administrator sets reasonable expectations for everyone.
  • The successful administrator knows marketing and sales.
  • The successful administrator recognizes and rewards people for performance.

No one said it would be easy. But rewards are numerous: Gratitude for high-quality care, providing a sense of security for both the resident and family members, unique, fascinating stories from people of varied experiences and giving—and receiving—peace of mind in a caring setting. Is this career right for you? Check out our site and then get busy making plans.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Association of Long Term Care Administrators Boards (NAB) and American College of Health Care Administrators (ACHCA). National Administrator-in-Training Program Manual.

  2. National Association of Long Term Care Administrator Boards. Practice exams.

By Anthony Cirillo
Anthony Cirillo, FACHE, ABC, is a writer, consultant, and professional speaker who helps family caregivers and individuals make educated aging decisions.